Post Nasal Drip

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What is Post Nasal Drip (PND)?

Postnasal drip (PND), is an abnormal sensation of mucous building up in the back of the throat or dripping down from the back of the nose. PND is usually from too much mucous being produced, or from problems with swallowing the secretions properly.

Normal Secretions

Glands that line the inside of your nose and sinuses naturally produce thin mucous. This mucous is continuously pushed backwards towards the throat, where it is swallowed unconsciously. This thin layer of mucous secretions is normal and has several important roles including: lubricating and cleaning the nose, humidifying inhaled air, trapping and clearing foreign debris, and fighting infections. Issues with postnasal drip can arise with abnormal secretions, that are more than the natural levels produced.

Abnormal Secretions

Abnormally increased thin secretions can be caused by many things including: colds or flu, nasal allergies, cold temperatures, bright lights, foods or spices, pregnancy or hormonal changes, birth control pills, blood pressure medications, or a deviated nasal septum. Vasomotor rhinitis is a non-allergic condition where the nose is irritated and congested; it can also be associated with increased thin abnormal postnasal drip.

Abnormally thick secretions can be caused by dry air in the house. They can also be associated with infections of the nose and sinuses, or certain food allergies. After a cold, thick green secretions can be a sign of a developing bacterial sinus infection.

Sometimes when thin secretions are abnormally decreased, a sensation of thick dry secretions can be felt. This can be caused by chronic exposure to irritants such as cigarette smoke, industrial pollution, and automobile exhaust. Another cause can be from turbulent airflow from a deviated nasal septum drying out the nose. The third cause can be advanced age, which is associated with thicker mucous that is more difficult to swallow.

Swallowing Problems

Problems with swallowing normal or abnormal mucous secretions can be attributed to several things:

Muscles of swallowing can become weak and uncoordinated with advanced age. This can make even normal thin secretions difficult to pass.

Swallowing is less active during sleep, this is why there are more secretions and throat clearing in the mornings upon awakening.

Anxiety or stress can produce muscle spasms that affect the muscles of swallowing or give the sensation of a lump in the throat.

Growths or tumors of the swallowing passages can block mucous or food from passing.

Acid reflux from the stomach, traveling up the throat can contribute to swallowing dysfunction.

Treatment of Postnasal Drip

Appropriate treatment depends on the cause of the problem. Accurate diagnosis is made with a thorough head and neck examination and possible lab, endoscopic, and imaging studies.

Bacterial infections of the nose and sinuses are treated with antibiotics. If the condition is not adequately addressed with the appropriate antibiotic course, there may be a chronic sinusitis that requires drainage.

The first step in addressing allergies is avoiding the causes as much as possible. The next step, symptomatic relief can be provided by various medications including decongestants, nasal steroid sprays, antihistamines. The third step, immunotherapy can be delivered via allergy shots or drops under the tongue. Each of these agents carries certain risks and benefits that must be discussed with your prescribing physician.

Elevating the head during sleep, avoiding late night meals, and curtailing alcohol, caffeine, dark chocolate, fatty foods, mint, spicy food, and citrus foods can be the first steps in addressing gastroesophageal reflux of acid. Medication options include antacids, and acid blockers.

Certain structural abnormalities can prevent smooth passage of air or proper ventilation of the sinus passageways. As a result, chronic inflammation and abnormal postnasal drip may ensue. Proper correction of the anatomic abnormality is done with the appropriate surgical procedure, including septoplasty, turbinate reduction, and endoscopic sinus surgery.

In cases without a specific cause of postnasal drip, treatment is focused on moistening and thinning the secretions so that they can go down the throat more easily. The first step is to drink adequate water (a common deficiency in elderly patients with dry throats). If possible, avoiding caffeine and diuretics can help maintain hydration. Medication options include guaifenesin and organic iodine that work by thinning the mucous.

Another way to thin secretions is to wash them down with nasal irrigations. These can be done one to six times daily. Warm water can be mixed with salt or baking soda. The salt mixture is generally ½ tablespoon for each pint of water. Alkalol is an effective over-the-counter irrigation solution as well. Also, over-the-counter nasal saline sprays such as Ocean,® Ayr,® and Nasal,® are very helpful.

Many patients who suffer from postnasal drip will complain about a chronic sore throat with discomfort and the sensation of a lump. Although repeated throat cultures in these cases usually do not show infections growing, the dripping secretions cause inflammation, swelling, and discomfort of the tonsils and throat tissues. Effective treatment of the postnasal drip will help with these throat symptoms.